Emergency monitor-defibrillator with telemedicine capability and remote activation

ABSTRACT

In embodiments, an emergency external defibrillator system is configured for use by a local rescuer in cooperation with a remote rescuer to assist a patient. The external defibrillator system includes a sensor to generate a patient value that represents a physiological parameter of the patient. The system also includes a communication module to transmit the patient value to another device of a remote rescuer, and to receive in response an incoming message that contains an encoded discharge instruction. The system also includes a processor that can decode the discharge instruction, and cause the system to defibrillate or pace the patient. An advantage is that therapy can be initiated remotely from the remote rescuer, who may be better trained, more confident, and less under the stress of the moment than the local rescuer.

CROSS REFERENCE TO RELATED PATENT APPLICATIONS

This patent application is a divisional of U.S. patent application Ser.No. 14/718,403, filed on May 21, 2015, which in turn claims priorityfrom U.S. Provisional Patent Application Ser. No. 62/007,367, filed onJun. 3, 2014, the disclosure of which is hereby incorporated byreference.

BACKGROUND

In humans, the heart beats to sustain life. In normal operation, itpumps blood through the various parts of the body, thanks to itselectrical control system. More particularly, the sinoatrial (SA) nodegenerates an electrical impulse, which generates further electricalsignals. These further signals cause the various heart chambers tocontract in the correct sequence. The electrical pattern created by thesinoatrial (SA) node is called a sinus rhythm.

Sometimes, however, the electrical control system of the heartmalfunctions, which can cause the heart to beat irregularly, or not atall. The cardiac rhythm is then generally called an arrhythmia.Arrhythmias may be caused by electrical activity from locations in theheart other than the SA node. Some types of arrhythmia may result ininadequate blood flow, thus reducing the amount of blood pumped to thevarious parts of the body. Some arrhythmias may even result in a SuddenCardiac Arrest (SCA). In a SCA, the heart fails to pump bloodeffectively, and, if not treated, death can occur. In fact, it isestimated that SCA results in more than 250,000 deaths per year in theUnited States alone. Further, a SCA may result from a condition otherthan an arrhythmia.

One type of arrhythmia associated with SCA is known as VentricularFibrillation (VF). VF is a type of malfunction where the ventricles makerapid, uncoordinated movements, instead of the normal contractions. Whenthat happens, the heart does not pump enough blood to deliver enoughoxygen to the vital organs. The person's condition will deterioraterapidly and, if not reversed in time, they will die soon, e.g. withinten minutes. A present or prior VF episode is when a person typicallystarts becoming characterized as a patient in these contexts.

Ventricular Fibrillation can often be reversed using a life-savingdevice called a defibrillator. A defibrillator, if applied properly, canadminister an electrical shock to the heart. The shock may terminate theVF, thus giving the heart the opportunity to resume pumping blood. If VFis not terminated, the shock may be repeated, often at escalatingenergies.

A challenge with defibrillation is that the electrical shock must beadministered very soon after the onset of VF. There is not much time:the survival rate of patients suffering from VF decreases by about 10%for each minute the administration of a defibrillation shock is delayed.After about 10 minutes, the rate of survival for SCA victims averagesless than 2%.

VF can occur unpredictably, even to a patient who is not considered atrisk. When VF occurs, the patient collapses, because blood flow hasstopped. They should receive therapy quickly. A different type ofdefibrillator can be used, which is called an external defibrillator.External defibrillators have been made portable, so they can be broughtto a potential VF victim quickly enough to revive them.

A situation of a VF is unpredictable, unexpected, and fraught withdanger for the victim. Even a trained rescuer may perform lessoptimally, under the intensity of the moment.

BRIEF SUMMARY

The present description gives instances of devices, systems, storagemedia that store programs, and methods, the use of which may helpovercome problems and limitations of the prior art.

In embodiments, an emergency external defibrillator system is configuredfor use by a local rescuer in cooperation with a remote rescuer, toassist a patient. The external defibrillator system includes a sensor togenerate a patient value that represents a physiological parameter ofthe patient. The system also includes a communication module to transmitthe patient value to another device of a remote rescuer, and to receivein response an incoming message that contains an encoded sound. For thelocal rescuer, the system also includes a screen to display the patientvalue, and a speaker to play the sound concurrently with the screendisplaying the patient value. An advantage is that the local rescuer canreceive guidance from the remote rescuer.

In embodiments, an emergency external defibrillator system is configuredfor use by a local rescuer in cooperation with a remote rescuer toassist a patient, and for remote activation by the remote rescuer. Theexternal defibrillator system includes a sensor to generate a patientvalue that represents a physiological parameter of the patient. Thesystem also includes a communication module to transmit the patientvalue to another device of a remote rescuer, and to receive in responsean incoming message that contains an encoded discharge instruction. Thesystem also includes a processor that can decode the dischargeinstruction, and cause the system to defibrillate or pace the patient.An advantage is that therapy can be initiated remotely from the remoterescuer, who may be better trained, more confident, and less under thestress of the moment than the local rescuer.

These and other features and advantages of this description will becomemore readily apparent from the Detailed Description, which proceeds withreference to the associated drawings in which:

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a diagram of a scene where an external defibrillator system isused to save the life of a patient according to embodiments.

FIG. 2 is a table listing two main types of the external defibrillatorsystem shown in FIG. 1, and who they might be used by.

FIG. 3 is a diagram showing components of a sample externaldefibrillator system, such as the one shown in FIG. 1, which is madeaccording to embodiments.

FIG. 4 is a diagram showing sample components of an externaldefibrillator system that is made and operates according to embodiments.

FIG. 5 is a diagram of a sample authentication scheme according toembodiments.

FIG. 6 is a diagram showing sample components of an externaldefibrillator system according to an embodiment where an incoming imageis displayed concurrently with a sound being played.

FIG. 7 is a diagram showing sample components of an externaldefibrillator system according to another embodiment where an incomingimage is displayed concurrently with a sound being played.

FIG. 8 is a flowchart for illustrating methods according to embodiments.

FIG. 9 is a diagram showing sample components of an externaldefibrillator system that is made and operates according to embodiments.

FIG. 10 is a flowchart for illustrating methods according toembodiments.

DETAILED DESCRIPTION

As has been mentioned, the present description is about devices,systems, storage media that store programs, and methods. Embodiments arenow described in more detail.

FIG. 1 is a diagram of a defibrillation scene. A patient 82 is lying onhis back. Patient 82 could be a patient in a hospital, or a pre-hospitalpatient such as someone found initially unconscious. Patient 82 isexperiencing a condition in their heart 85, which could be VentricularFibrillation (VF). VF can be preceded by Ventricular Tachycardia (VT).

A portable external defibrillator system 100 has been brought close topatient 82. At least two defibrillation electrodes 104, 108 are usuallyprovided with external defibrillator system 100, and are sometimescalled electrodes 104, 108. Electrodes 104, 108 are coupled withexternal defibrillator system 100 via respective electrode leads 105,109. A rescuer (not shown) has attached electrodes 104, 108 to the skinof patient 82. Defibrillator system 100 is administering, via electrodes104, 108, a brief, strong electric pulse 111 through the body of patient82. Pulse 111, also known as a defibrillation shock, goes also throughheart 85, in an attempt to restart it, for saving the life of patient82.

Defibrillator system 100 can be one of different types, each withdifferent sets of features and capabilities. The set of capabilities ofdefibrillator system 100 is determined by planning who would use it, andwhat training they would be likely to have. Examples are now described.

FIG. 2 is a table listing two main types of external defibrillators, andwho they are primarily intended to be used by. A first type ofdefibrillator system 100 is generally called a defibrillator-monitor,because it is typically formed as a single unit in combination with apatient monitor. A defibrillator-monitor is sometimes calledmonitor-defibrillator. A defibrillator-monitor is intended to be used bypersons in the medical professions, such as doctors, nurses, paramedics,emergency medical technicians, etc. Such a defibrillator-monitor isintended to be used in a pre-hospital or hospital scenario.

As a defibrillator, the device can be one of different varieties, oreven versatile enough to be able to switch among different modes thatindividually correspond to the varieties. One variety is that of anautomated defibrillator, which can determine whether a shock is neededand, if so, charge to a predetermined energy level and instruct the userto administer the shock. Another variety is that of a manualdefibrillator, where the user determines the need and controlsadministering the shock.

As a patient monitor, the device has features additional to what isminimally needed for mere operation as a defibrillator. These featurescan be for monitoring physiological indicators of a patient in anemergency scenario. These physiological indicators are also calledphysiological parameters, and are typically monitored as signals. Forexample, these physiological parameters can include a patient's full ECG(electrocardiogram) signals, or impedance between two electrodes.Additionally, these physiological parameters can be, according toembodiments, the physiological parameter can be one of the patient'speripheral capillary oxygen saturation/pulse oximetry (SpO2),carboxyhemoglobin, methemoglobin (SpMet), a concentration or partialpressure of carbon dioxide in the respiratory gases that is also knownas capnography and end-tidal carbon dioxide (EtCO2), Non-Invasive BloodPressure (NIBP), tissue oxygen saturation (StO2), temperature, aregional oxygen saturation index (Rs-O2), and an invasive pressure.These physiological parameters can be further stored and/or transmittedas patient data.

The patient's peripheral capillary oxygen saturation (SpO2), is anestimation of the oxygen saturation level. Oxygen saturation is a termreferring to the concentration of oxygen in the blood. It measures thepercentage of hemoglobin binding sites in the bloodstream occupied byoxygen.

Carboxyhemoglobin is a measurement that allows clinicians tononinvasively and quickly detect elevated levels of carbon monoxide inthe blood-facilitating earlier diagnosis and treatment, for patientspoisoned by carbon monoxide.

Tissue oxygen saturation can include measuring hemoglobin oxygensaturation in the microcirculation, where oxygen diffuses to tissuecells. In some embodiments, measuring tissue oxygen saturation permitsreal-time, continuous monitoring of peripheral perfusion.

A second type of external defibrillator system 100 is generally calledan AED, which stands for “Automated External Defibrillator”. An AEDtypically makes the shock/no shock determination by itself,automatically. Indeed, it can sense enough physiological conditions ofthe patient 82 via only the shown defibrillation electrodes 104, 108 ofFIG. 1. In its present embodiments, an AED can either administer theshock automatically, or instruct the user to do so, e.g. by pushing abutton. Being of a much simpler construction, an AED typically costsmuch less than a defibrillator-monitor. As such, it makes sense for ahospital, for example, to deploy AEDs at its various floors, in case themore expensive defibrillator-monitor is more critically being deployedat an Intensive Care Unit, and so on.

AEDs, however, can also be used by people who are not in the medicalprofessions. More particularly, an AED can be used by many professionalfirst responders, such as policemen, firemen, etc. Even a person withfirst-aid and CPR/AED training can use one. And AEDs increasingly cansupply instructions to whoever is using them.

AEDs are thus particularly useful, because it is so critical to respondquickly, when a patient suffers from VF. Indeed, the people who willfirst reach the VF sufferer may not be in the medical professions.

Increasing awareness has resulted in AEDs being deployed in public orsemi-public spaces, so that even a member of the public can use one, ifthey have obtained first aid and CPR/AED training on their owninitiative. This way, defibrillation can be administered soon enoughafter the onset of VF, to hopefully be effective in rescuing thepatient.

There are additional types of external defibrillators, which are notlisted in FIG. 2. For example, a hybrid defibrillator can have aspectsof an AED, and also of a defibrillator-monitor. A usual such aspect isadditional ECG monitoring capability.

FIG. 3 is a diagram showing components of an external defibrillatorsystem 300 made according to embodiments. These components can be, forexample, in external defibrillator system 100 of FIG. 1. Thesecomponents of FIG. 3 can be provided in a housing 301, which is alsoknown as casing 301. One or more of them can be provided in anApplication Specific Integrated Circuit (“ASIC”).

External defibrillator system 300 is intended for use by a user 380, whowould be the rescuer. Defibrillator system 300 typically includes adefibrillation port 310, such as a socket in housing 301. Defibrillationport 310 includes nodes 314, 318. Defibrillation port 310 can beconfigured such that defibrillation electrodes 304, 308, which can besimilar to electrodes 104, 108, can be electrically coupled todefibrillation port 310. For example, defibrillation electrodes 304, 308can be plugged into defibrillation port 310 so as to make electricalcontact with nodes 314, 318, respectively. It is also possible thatelectrodes can be connected continuously to defibrillation port 310,etc. Either way, defibrillation port 310 can be configured such that anelectrical charge that has been stored in defibrillator system 300 canbe guided through defibrillation port 310 via electrodes 304, 308 to thepatient (not shown in FIG. 3). The electrical charge may have beenstored in defibrillator system 300 as will be seen later in thisdocument.

If defibrillator system 300 is actually a defibrillator-monitor, as wasdescribed with reference to FIG. 2, then it will typically also have anECG port 319 in housing 301, for plugging in ECG leads 309. ECG leads309 can help sense an ECG signal, e.g. a 12-lead signal, or from adifferent number of leads. Moreover, a defibrillator-monitor could haveadditional ports (not shown).

Additionally, a defibrillator system according to embodiments could havea sensor. The sensor can be configured to measure a physiologicalparameter of a patient, and to generate a patient value in response tothe measured physiological parameter. The sensor can be measurementcircuit 320 that is described below, in which case the patient value isa value of an ECG signal or an impedance signal. Or, the sensor can beanother sensor 325, which may have any number of implementations asbeing the appropriate sensor for measuring a number of possiblephysiological parameters mentioned above.

Defibrillator system 300 also includes a measurement circuit 320.Measurement circuit 320 receives physiological signals from ECG port319, and also from other ports, if provided. These physiological signalsare sensed, and information about them is rendered by circuit 320 asdata, or other signals, etc.

If defibrillator system 300 is actually an AED, it may lack ECG port319. Measurement circuit 320 can obtain physiological signals throughnodes 314, 318 instead, when defibrillation electrodes 304, 308 areattached to patient 82. In these cases, a patient's ECG signal can besensed as a voltage difference between electrodes 304, 308. Plus,impedance between electrodes 304, 308 can be sensed for detecting, amongother things, whether electrodes 304, 308 have been inadvertentlydisconnected from the patient.

Defibrillator system 300 also includes a processor 330. Processor 330may be implemented in a number of ways. Such ways include, by way ofexample and not of limitation, digital and/or analog processors such asmicroprocessors and digital-signal processors (DSPs); controllers suchas microcontrollers; software running in a machine; programmablecircuits such as Field Programmable Gate Arrays (FPGAs),Field-Programmable Analog Arrays (FPAAs), Programmable Logic Devices(PLDs), Application Specific Integrated Circuits (ASICs), anycombination of one or more of these, and so on.

Processor 330 can be considered to have a number of modules. One suchmodule can be a detection module 332, which senses outputs ofmeasurement circuit 320. Detection module 332 can include a VF detector,a VT detector, and so on. Thus, the patient's sensed ECG can be used todetermine whether the patient is experiencing VF or VT.

Another such module in processor 330 can be an advice module 334, whicharrives at advice based on outputs of detection module 332. Advicemodule 334 can include a Shock Advisory Algorithm, implement decisionrules, and so on. The advice can be to shock, to not shock, toadminister other forms of therapy, and so on. If the advice is to shock,some external defibrillator embodiments merely report that to the user,and prompt them to do it. Other embodiments further execute the advice,by administering the shock. Shocking is by delivering a storedelectrical charge, which is also known as discharging. If the advice isto administer CPR, defibrillator system 300 may further issue promptsfor it, and so on.

Processor 330 can include additional modules, such as module 336, forother functions. In addition, other sensor 325 may be operated in partby processor 330, etc.

Defibrillator system 300 optionally further includes a memory 338, whichcan work together with processor 330. Memory 338 may be implemented inany number of ways. Such ways include, by way of example and not oflimitation, nonvolatile memories (NVM), read-only memories (ROM), randomaccess memories (RAM), any combination of these, and so on. Memory 338,if provided, can include programs for processor 330, and so on. Theprograms can be operational for the inherent needs of processor 330, andcan also include protocols and ways that decisions can be made by advicemodule 334. In addition, memory 338 can store prompts for user 380, etc.Moreover, memory 338 can store patient data.

Defibrillator system 300 may also include a power source 340. To enableportability of defibrillator system 300, power source 340 typicallyincludes a battery. Such a battery is typically implemented as a batterypack, which can be rechargeable or not. Sometimes, a combination isused, of rechargeable and non-rechargeable battery packs. Otherembodiments of power source 340 can include AC power override, for whereAC power will be available, and so on. In some embodiments, power source340 is controlled by processor 330.

Defibrillator system 300 additionally includes an energy storage module350. Module 350 can be configured to store electrical energy in the formof an electrical charge, when preparing it for sudden discharge toadminister a shock. Module 350 can be charged from power source 340 tothe right amount of energy, as controlled by processor 330. In typicalimplementations, module 350 includes one or more capacitors 352, and soon.

Defibrillator system 300 moreover includes a discharge circuit 355.Circuit 355 can be controlled to permit the energy stored in module 350to be discharged to nodes 314, 318, and thus also to defibrillationelectrodes 304, 308. Circuit 355 can include one or more switches 357.Switches 357 can be made in a number of ways, such as by an H-bridge,and so on.

Defibrillator system 300 further includes a user interface 370 for user380. User interface 370 can be made in any number of ways. For example,interface 370 may include output devices, which can be visual, audibleor tactile, for communicating to a user. An output device can beconfigured to output a warning, which warns or instructs the patient ora bystander to do something. An output device can be a light or a screento display what is detected and measured, and provide visual feedback tothe rescuer for their resuscitation attempts, and so on. Interface 370may also include a speaker, to issue voice prompts, etc. Sounds, images,vibrations, and anything that can be perceived by a human can also becalled human perceptible indications. Interface 370 may additionallyinclude input devices for receiving inputs from users. Such inputdevices may include various controls, such as pushbuttons, keyboards,touchscreens, a microphone, and so on. In addition, discharge circuit355 can be controlled by processor 330, or directly by user 380 via userinterface 370, and so on.

Defibrillator system 300 can optionally include other components. Forexample, a communication module 390 may be provided for communicatingwith other machines. Such communication can be performed wirelessly, orvia wire, or by infrared communication, and so on. This way, data can becommunicated, such as patient data, incident information, therapyattempted, CPR performance, and so on. Communication module 390, likeother modules and units in embodiments may be implemented by a singlemodule, multiple modules, etc.

FIG. 4 is a diagram showing sample components of an externaldefibrillator system 400 that is made according to embodiments. Externaldefibrillator system 400 can be a monitor-defibrillator that is used torespond to emergency patients in both the Hospital and Pre-HospitalEnvironments. System 400 can be configured for use by a local rescuer411 in cooperation with a remote rescuer 412 to assist a patient 482.Local rescuer 411 is typically a trained first responder, such as aparamedic, etc. Local rescuer 411 could also be a bystander. Remoterescuer 412 can be a doctor or other trained attendant who is advisingin this situation.

System 400 may be provided as a single device and maybe in a singlehousing. In some embodiments, some components, such as sensor 420, canbe separable from the remainder of the single device. System 400 canassist patient 482 with the help of electrodes 404, 408, which can beapplied by local rescuer 411. For example, local rescuer 411 can becapable of carrying external defibrillator system 400, and of attachingelectrodes 404, 408 to patient 482.

System 400 includes an energy storage module 450 that can be as energystorage module 350, a defibrillation port 410 that can be asdefibrillation port 310, and a sensor 420 that can be as measurementcircuit 320 or other sensor 325. Sensor 420 can be configured to measurea physiological parameter of patient 482, and to generate a patientvalue PV 421 in response to the measured physiological parameter, asdescribed in more detail above.

System 400 also includes a screen 472. Screen 472 can be part of abroader user interface for the use of local rescuer 411. This broaderuser interface may also include a speaker 471, another screen, etc.Screen 472 can be configured to display patient value PV 421 to localrescuer 411. This broader user interface may be used by local rescuer411 to operate system 400, and also possibly to communicate with remoterescuer 412.

System 400 also includes a communication module 490, which can be as wasdescribed for communication module 390. Communication module 490 can beconfigured to stream real-time patient information, which may includevital sign measurements, vital sign waveforms, and treatment eventinformation (drugs administered, shocks administered, pacingadministered, results of advanced diagnostic algorithms, video fromadvanced diagnostic tools such as video laryngoscope and ultrasound,location information, patient demographics, etc. In addition,communication module 490 may facilitate audio and video channels toprovide visual information of patient 482 and contextual informationfrom the scene.

In particular, communication module 490 can be configured to transmitpatient value PV 421 to another device 480 via a communication network482 that can be the internet. This transmission is indicated in FIG. 4with arrow 491, and can be through wireless or even wired connections. Avariety of wireless communication methods can be used to communicatefrom communication module 490 to the cloud, including but not limited toBluetooth, ZigBee, Wi-Fi, and all versions of Cellular (3G, 4G, LTE,GSM, GPRS, CDMA, etc.). A memory (not shown) may indicate an address ofother device 480 in network 482. From the point of view of system 400,other device 480 and remote rescuer 412 are in the cloud. Accesssecurity can be provided at the receiving ends, to ensure that data isavailable only to authorized users.

Other device 480 can be a computer system, a smartphone, a tablet, etc.,and can be used by remote rescuer 412. Only one remote rescuer 412 isshown, although there can be a number of them, and they could becommunicating with each other, plus with any destination care center.All such participating remote rescuers could be contributing data,diagnosis, advice and consults, alerts, and patient receipt readinessoperations. For example, a manager of the overall health care providersystem (e.g. Medical Director of an Emergency Medical System) canactively track the on-going care that is being provided throughout theirsystem, and join in real-time to provide guidance or advice.

Remote rescuer 412 may thus perceive patient value PV 421 from otherdevice 480, for example by viewing it on a screen, and makedeterminations about patient 482. Remote rescuer 412 may look up andsend previous patient treatment history or reference information,patient demographics and insurance information, and transmitcommunications with the caregivers via audio or text communication toaffect the care of patient 482, document patient and event informationassociated with the care of patient 482 including, Emergency Crewinformation, and make transport decisions.

Communication module 490 can be further configured to receive fromcommunication network 482 an incoming message 483. This reception isindicated in FIG. 4 with arrow 481. Incoming message 483 may or may notoriginate from other device 480.

Incoming message 483 may have been generated by remote rescuer 412responsive to perceiving patient value PV 421 from other device 480.Incoming message 483 can contain an encoded sound SD 484, which can beone or more segments of the speech of remote rescuer 412. Speaker 471can be configured to play sound SD 484 to local rescuer 411, afterdecoding it from incoming message 483. Sound SD 484 can be thus playedwith screen 472 displaying patient value PV 421. System 400 may alsoinclude a processor 430, which can be as processor 330, and which can beconfigured to decode sound SD 484 from incoming message 483, so thatsound SD 484 can be played on speaker 471. This way, the segments of thespeech can be played to construct the speech of remote rescuer 412 forguiding local rescuer 411. Local rescuer 411 may be assisted this way byremote rescuer 412, who may be better trained than local rescuer 411.

It will be appreciated that engaging remote rescuer 412 may not happenevery time. For example, there are times when system 400 is not used tohelp a patient. There can be other times when patient 482 is beinghelped, but local rescuer 411 has not had the opportunity to engageremote rescuer 412, or forgets, perhaps under the stress of the moment.

In some embodiments, if the patient value exceeds a threshold, system400 performs one or more additional functions automatically. The patientvalue, and the corresponding threshold, can be chosen according topossible conditions. For example, the patient value could be thepatient's temperature, indicating a fever. Or it could be a slope at acertain portion of an ECG waveform, indicating an AMI. Or it could be aninfinite impedance value, which could indicate that an electrode hasfallen off.

In such embodiments, communication module 490 can be configured to thustransmit patient value PV 421 automatically. Or, screen 472 can befurther configured to display a remote connect prompt to local rescuer411. Or, speaker 471 can be further configured to play a remote connectprompt to local rescuer 411.

In some embodiments, a processor of system 400, such as processor 430,is configured to determine whether incoming message 483 was indeedreceived in response to patient value PV 421 that was transmittedaccording to arrow 491. In other words, the incoming message isauthenticated first. In such embodiments, if it is not so determined,sound SD 484 is not played by speaker 471. A more particular example isnow described.

FIG. 5 is a diagram of a sample authentication scheme according toembodiments. A communication module 590, which can be as communicationmodule 490, is configured to transmit an outgoing message 599 to anotherdevice 580. This transmission can be according to arrow 591, and it isvia communication network 482. Other device 580 can be as other device480. Outgoing message 599 contains a patient value PV 521, which can beas patient value PV 421. Of course, patient value PV 521 is in encodedform, for transmission via communication network 482. In addition,outgoing message 599 may contain a send key code SKC 595. Send key codeSKC 595 can be generated in a number of ways, for example as a hash ofpatient value PV 521, from a time stamp, etc.

Communication module 590 is configured to further receive an incomingmessage 583 via communication network 482, as shown by arrow 581.Incoming message 583 contains an encoded sound SD 584, and the desire isto authenticate whether that sound SD 584 is indeed received in responseto the transmitted patient value PV 521. Incoming message 583 alsocontains a return key code RKC 585. In such embodiments, thedetermination of whether incoming message 583 was indeed received inresponse to transmitted patient value PV 521 is performed by comparingreturn key code RKC 585 to send key code SKC 595.

In some embodiments, the incoming message further contains an encodedimage, which can even be part of a stream of images. In suchembodiments, an external defibrillator system can display the image, andeven the stream of images, after decoding. Examples are now described.

FIG. 6 is a diagram showing sample components of an externaldefibrillator system 600 that has a communication module 690. System 600includes a speaker 671 and a screen 672. A sensor (not shown) generatesa patient value 621 that is shown on screen 672. In this example,patient value 621 is a waveform of impedance while the patient isreceiving CPR chest compressions. It will be observed that initially theimpedance oscillates consistently with the administration of CPR, andthen it becomes a flat maximum value.

Communication module 690 receives an incoming message 683 according toan arrow 681. Incoming message 683 contains an encoded sound SD 684,which is played as a decoded sound 674 by speaker 671.

Incoming message 683 further contains an encoded image IMG 686. Screen672 is further configured to display the decoded image 676, concurrentlywith displaying patient value 621.

FIG. 7 is a diagram showing sample components of an externaldefibrillator system 700 that has a communication module 790. System 700includes a speaker 771, a screen 772, and another screen 752. A sensor(not shown) generates a patient value 721 that is shown on screen 772,and which is similar to patient value 621.

Communication module 790 receives an incoming message 783 according toan arrow 781. Incoming message 783 contains an encoded sound SD 784,which is played as a decoded sound 774 by speaker 771.

Incoming message 783 further contains an encoded image IMG 786. Screen752 is configured to display the decoded image 776, concurrently withscreen 772 displaying patient value 721.

The devices and/or systems mentioned in this document perform functions,processes and/or methods. These functions, processes and/or methods maybe implemented by one or more devices that include logic circuitry. Sucha device can be alternately called a computer, and so on. It may be astandalone device or computer, such as a general purpose computer, orpart of a device that has one or more additional functions. The logiccircuitry may include a processor that may be programmable for a generalpurpose, or dedicated, such as a microcontroller, a microprocessor, aDigital Signal Processor (DSP), etc. The logic circuitry may alsoinclude non-transitory computer-readable storage media, such asmemories. Such media can be of different types including but not limitedto volatile memory, non-volatile memory (NVM), read only memory (ROM);random access memory (RAM); magnetic disk storage media; optical storagemedia; smart cards, flash memory devices, etc. These storage media,individually or in combination with others, can have stored thereondata. In addition, these storage media may store programs that theprocessor may be able to read, and execute. More particularly, theprograms can include instructions in the form of code, which theprocessor may be able to execute upon reading. Executing is performed byphysical manipulations of physical quantities, and may result in thefunctions, processes, actions and/or methods to be performed, and/or theprocessor to cause other devices or components or blocks to perform suchfunctions, processes, actions and/or methods. Often, for the sake ofconvenience only, it is preferred to implement and describe a program asvarious interconnected distinct software modules or features. These,along with data are individually and also collectively known assoftware. In some instances, software is combined with hardware, in amix called firmware.

Moreover, methods and algorithms are described below. These methods andalgorithms are not necessarily inherently associated with any particularlogic device or other apparatus. Rather, they are advantageouslyimplemented by programs for use by a computing machine, such as ageneral-purpose computer, a special purpose computer, a microprocessor,etc. These algorithms are not necessarily purely mathematical, and areconfigured to address challenges particular to the problem solved, aswill be apparent to a person skilled in the art.

This detailed description includes flowcharts, display images,algorithms, and symbolic representations of program operations within atleast one computer readable medium. An economy is achieved in that asingle set of flowcharts is used to describe both programs, and alsomethods. So, while flowcharts describe methods in terms of boxes, theyalso concurrently describe programs.

Methods are now described.

FIG. 8 shows a flowchart 800 for describing methods according toembodiments. According to an operation 810, an electrical charge isstored.

According to another operation 820, the stored electrical charge isguided through the defibrillation port and through electrodes to apatient.

According to another operation 830, a physiological parameter of thepatient is measured. The physiological parameter can be the patient'sECG signal, impedance signal, peripheral capillary oxygen saturation,carboxyhemoglobin, methemoglobin, end-tidal carbon dioxide, non-invasiveblood pressure, tissue oxygen saturation, temperature, a regional oxygensaturation index, and an invasive pressure.

According to one more operation 840, a patient value is generated inresponse to the measured physiological parameter.

According to another operation 850, the patient value is transmitted toanother device via a communication network. The transmission can beinitiated by a local rescuer, or performed routinely as part of theestablished communication with the other device of the remote rescuer.In some embodiments, the patient value is transmitted automatically ifthe patient value exceeds a threshold. Or, a remote connect prompt isissued to a local rescuer if this happens. The remote connect can bedisplayed as an image, played as a sound prompt, etc. Upon perceivingthe remote connect prompt, a local rescuer may initiate the connectionand operation 850.

According to another operation 860, an incoming message is received fromthe communication network. The incoming message contains an encodedsound. The sound may be decoded from the incoming message.

According to another operation 870, the patient value of operation 840is displayed on a screen.

According to another operation 880, the sound is played concurrentlywith displaying the patient value on the screen. In embodiments, it isfurther determined whether the incoming message was received in responseto the transmitted patient value. If it is not so determined, the soundis not output from the speaker. The determination may take place asdescribed above.

In some embodiments, the incoming message further contains an encodedimage. In such embodiments, the image can be further displayed.

Returning to FIG. 4, in some embodiments remote rescuer 412 can alsoactivate the defibrillation system 400, so as to discharge the storedcharge through the patient and thus deliver electrotherapy. Thedischarge can be for defibrillation, pacing, etc. In other embodiments,the remote activation can take place without some of the features oroperations of system 400. Accordingly, remote activation is nowdescribed as if it were a separate capability, although the descriptionbelow can be extended capabilities for system 400 according toembodiments.

FIG. 9 is a diagram showing sample components of an externaldefibrillator system 900 that is made according to embodiments. Externaldefibrillator system 900 can be a monitor-defibrillator that is used torespond to emergency patients in both the Hospital and Pre-HospitalEnvironments. System 900 is configured for use by a local rescuer 911 incooperation with a remote rescuer 912 to assist a patient 982, similarlywith what was described for FIG. 4. System 900 can assist patient 982with the help of electrodes 904, 908, which can be applied by localrescuer 911.

Other features can also be as described in FIG. 4. For example, system900 includes an energy storage module 950 that can be as energy storagemodule 350, a defibrillation port 910 that can be as defibrillation port310, and a sensor 920 that can be as measurement circuit 320 or othersensor 325. Sensor 920 can be configured to measure a physiologicalparameter of patient 982, and to generate a patient value PV 921 inresponse to the measured physiological parameter, as described in moredetail above. In addition, a user interface (not shown in FIG. 9) may beprovided for local rescuer 911 to operate system 900, and also possiblyto communicate with remote rescuer 912.

System 900 also includes a communication module 990, which can be as wasdescribed for communication module 390. Communication module 990 can beconfigured to transmit patient value PV 921 to another device 980 via acommunication network 482. This transmission is indicated in FIG. 9 witharrow 991. Other device 980 can be as other device 480, and can be usedby remote rescuer 912. Remote rescuer 912 may thus view patient value PV921 on other device 980, and make determinations about patient 982.

Communication module 990 can be further configured to receive fromcommunication network 482 an incoming message 983. This reception isindicated in FIG. 9 with arrow 981. Incoming message 983 may or may notoriginate from other device 980.

Incoming message 983 may have been generated by remote rescuer 912responsive to perceiving patient value PV 921 from other device 980.Incoming message 983 can contain an encoded discharge instruction DI988.

System 900 may also include a processor 930, which can be as processor330. Processor 930 can be configured to decode discharge instruction DI988 from incoming message 983. Processor 930 can be further configuredto cause, responsive to the decoded discharge instruction, theelectrical charge stored in module 950 to be guided via defibrillationport 910 and via electrodes 904, 908 to patient 982 for administeringtherapy.

This way, remote rescuer 912 can remotely activate defibrillator system900 by transmitting discharge instruction DI 988. Remote rescuer 912 mayhave more confidence in performing this drastic action than localrescuer 911.

Other previously described features may also apply. For example, in someembodiments, if the patient value exceeds a threshold, system 900performs one or more additional functions automatically. In suchembodiments, communication module 990 could be configured to thustransmit patient value PV 921 automatically, and so on. Or, if aninterface is included, a remote connect prompt can be issued to localrescuer 911.

For another example, in some embodiments, a processor of system 900,such as processor 930, is configured to determine whether incomingmessage 983 was indeed received in response to patient value PV 921 thatwas transmitted according to arrow 991. In other words, the incomingmessage is authenticated first. In such embodiments, if it is not sodetermined, the stored electrical charge is not so guided, and so on.Authentication may happen in a number of ways, for example as wasdescribed in FIG. 5.

FIG. 10 shows a flowchart 1000 for describing methods according toembodiments. Operations 1010, 1030, 1040 and 1050 are similar tooperations 810, 830, 840 and 850 respectively.

According to another operation 1060, an incoming message is receivedfrom the communication network. The incoming message contains an encodeddischarge instruction.

According to another operation 1070, the discharge instruction isdecoded from the incoming message.

According to another operation 1090, responsive to the decoded dischargeinstruction, the stored electrical charge is caused to be guided via thedefibrillation port and via the coupled electrodes to the patient. Insome embodiments, it is further determined whether the incoming messagewas received in response to the transmitted patient value. If it is notso determined, then the stored electrical charge is not caused to be soguided. The determination may take place as described above.

In the methods described above, each operation can be performed as anaffirmative step of doing, or causing to happen, what is written thatcan take place. Such doing or causing to happen can be by the wholesystem or device, or just one or more components of it. It will berecognized that the methods and the operations may be implemented in anumber of ways, including using systems, devices and implementationsdescribed above. In addition, the order of operations is not constrainedto what is shown, and different orders may be possible according todifferent embodiments. Examples of such alternate orderings may includeoverlapping, interleaved, interrupted, reordered, incremental,preparatory, supplemental, simultaneous, reverse, or other variantorderings, unless context dictates otherwise. Moreover, in certainembodiments, new operations may be added, or individual operations maybe modified or deleted. The added operations can be, for example, fromwhat is mentioned while primarily describing a different system,apparatus, device or method.

A person skilled in the art will be able to practice the presentinvention in view of this description, which is to be taken as a whole.Details have been included to provide a thorough understanding. In otherinstances, well-known aspects have not been described, in order to notobscure unnecessarily this description. Plus, any reference to any priorart in this description is not, and should not be taken as, anacknowledgement or any form of suggestion that such prior art formsparts of the common general knowledge in any country or any art.

This description includes one or more examples, but this fact does notlimit how the invention may be practiced. Indeed, examples, instances,versions or embodiments of the invention may be practiced according towhat is described, or yet differently, and also in conjunction withother present or future technologies. Other such embodiments includecombinations and sub-combinations of features described herein,including for example, embodiments that are equivalent to the following:providing or applying a feature in a different order than in a describedembodiment; extracting an individual feature from one embodiment andinserting such feature into another embodiment; removing one or morefeatures from an embodiment; or both removing a feature from anembodiment and adding a feature extracted from another embodiment, whileproviding the features incorporated in such combinations andsub-combinations.

In this document, the phrases “constructed to” and/or “configured to”denote one or more actual states of construction and/or configurationthat is fundamentally tied to physical characteristics of the element orfeature preceding these phrases and, as such, reach well beyond merelydescribing an intended use. Any such elements or features can beimplemented in a number of ways, as will be apparent to a person skilledin the art after reviewing the present disclosure, beyond any examplesshown in this document.

Any and all parent, grandparent, great-grandparent, etc. patentapplications, whether mentioned in this document or in an ApplicationData Sheet (ADS) of this patent application, are hereby incorporated byreference herein, including any priority claims made in thoseapplications and any material incorporated by reference, to the extentsuch subject matter is not inconsistent herewith.

In this description a single reference numeral may be used consistentlyto denote a single aspect, component, or process. Moreover, a furthereffort may have been made in the drafting of this description to choosesimilar though not identical reference numerals to denote versions orembodiments of an aspect, component or process that are the same orpossibly different. Where made, such a further effort was not required,but was nevertheless made gratuitously to accelerate comprehension bythe reader. Even where made in this document, such an effort might nothave been made completely consistently throughout the many versions orembodiments that are made possible by this description. Accordingly, thedescription controls. Any similarity in reference numerals may be usedto confirm a similarity in the text, or even possibly a similarity whereexpress text is absent, but not to confuse aspects where the text or thecontext indicates otherwise.

The claims of this document define certain combinations andsubcombinations of elements, features and steps or operations, which areregarded as novel and non-obvious. Additional claims for other suchcombinations and subcombinations may be presented in this or a relateddocument. These claims are intended to encompass within their scope allchanges and modifications that are within the true spirit and scope ofthe subject matter described herein. The terms used herein, including inthe claims, are generally intended as “open” terms. For example, theterm “including” should be interpreted as “including but not limitedto,” the term “having” should be interpreted as “having at least,” etc.If a specific number is ascribed to a claim recitation, this number is aminimum but not a maximum unless stated otherwise. For example, where aclaim recites “a” component or “an” item, it means that it can have oneor more of this component or item.

What is claimed is:
 1. An external defibrillator system configured foruse by a local rescuer in cooperation with a remote rescuer to assist apatient, the local rescuer capable of carrying the externaldefibrillator system and of attaching electrodes to the patient, theexternal defibrillator system comprising: an energy storage moduleconfigured to store an electrical charge; a defibrillation portconfigured such that the electrodes can be electrically coupled to thedefibrillation port by the local rescuer; a sensor configured to measurea physiological parameter of the patient, and to generate a patientvalue in response to the measured physiological parameter; acommunication module configured to transmit the patient value to anotherdevice via a communication network, the communication module furtherconfigured to receive from the communication network an incomingmessage, the incoming message generated by the remote rescuer responsiveto perceiving the patient value from the other device, the incomingmessage containing an encoded discharge instruction; a processorconfigured to: decode the discharge instruction from the incomingmessage, and cause, responsive to the decoded discharge instruction, thestored electrical charge to be guided via the defibrillation port andvia the coupled electrodes to the patient.
 2. The external defibrillatorsystem of claim 1, in which the patient value is a value of an ECGsignal or an impedance signal.
 3. The external defibrillator system ofclaim 1, in which the physiological parameter is one of the patient'speripheral capillary oxygen saturation, carboxyhemoglobin,methemoglobin, end-tidal carbon dioxide, non-invasive blood pressure,tissue oxygen saturation, temperature, a regional oxygen saturationindex, and an invasive pressure.
 4. The external defibrillator system ofclaim 1, in which the communication module is configured to thustransmit the patient value automatically responsive to the patient valueexceeding a threshold.
 5. The external defibrillator system of claim 1,further comprising: a processor configured to determine whether theincoming message was received in response to the transmitted patientvalue, and if it is not so determined, the stored electrical charge isnot so guided.
 6. The external defibrillator system of claim 5, in whichthe communication module is configured to transmit an outgoing messageto the other device, the outgoing message contains the patient value inencoded form, the outgoing message contains a send key code, theincoming message contains a return key code, and the determination isperformed by comparing the return key code to the send key code.
 7. Theexternal defibrillator system of claim 6, in which the send key code isgenerated as a hash of the patient value.
 8. A non-transitorycomputer-readable storage medium storing one or more programs, at leastone of the one or more programs including a protocol, in which, when theone or more programs are executed by an external defibrillator systemthat includes a processor that is configured to operate according to theprotocol, an energy storage module, a defibrillation port configuredsuch that electrodes can be electrically coupled to the defibrillationport, a sensor, and a communication module, they result in operationscomprising: storing an electrical charge in the energy storage module;measuring, by the sensor, a physiological parameter of the patient;generating a patient value in response to the measured physiologicalparameter; transmitting, by the communication module, the patient valueto another device via a communication network; receiving via thecommunication network an incoming message, the incoming messagecontaining an encoded discharge instruction, the incoming messagegenerated by a remote human rescuer responsive to the remote rescuerperceiving the patient value from the other device; decoding thedischarge instruction from the incoming message; and causing, responsiveto the decoded discharge instruction, the stored electrical charge to beguided via the defibrillation port and via the coupled electrodes to thepatient, but in which the stored protocol does not become alteredresponsive to the incoming message.
 9. The medium of claim 8, in whichthe patient value is a value of an ECG signal or an impedance signal.10. The medium of claim 8, in which the physiological parameter is oneof the patient's peripheral capillary oxygen saturation,carboxyhemoglobin, methemoglobin, end-tidal carbon dioxide, non-invasiveblood pressure, tissue oxygen saturation, temperature, a regional oxygensaturation index, and an invasive pressure.
 11. The medium of claim 8,in which the patient value is transmitted automatically responsive tothe patient value exceeding a threshold.
 12. The medium of claim 8, inwhich when the one or more programs are so executed, they result in theoperations to further comprise: determining whether the incoming messagewas received in response to the transmitted patient value, and in whichif it is not so determined, the stored electrical charge is not causedto be so guided.
 13. The medium of claim 12, in which the communicationmodule transmits an outgoing message to the other device, the patientvalue is encoded in the outgoing message, the outgoing message includesa send key code, the incoming message includes a return key code, andthe determination is performed by comparing the return key code to thesend key code.
 14. The medium of claim 13, in which the send key code isgenerated as a hash of the patient value.
 15. A method for an externaldefibrillator system that includes an energy storage module, adefibrillation port configured such that electrodes can be electricallycoupled to the defibrillation port, a sensor, and a communicationmodule, the method comprising: storing an electrical charge in theenergy storage module; measuring, by the sensor, a physiologicalparameter of the patient; generating a patient value in response to themeasured physiological parameter; transmitting, by the communicationmodule, the patient value to another device via a communication network;receiving via the communication network an incoming message, theincoming message generated by a remote human rescuer responsive to theremote rescuer perceiving the patient value from the other device, theincoming message containing an encoded discharge instruction; decodingthe discharge instruction from the incoming message; and causing,responsive to the decoded discharge instruction, the stored electricalcharge to be guided via the defibrillation port and via the coupledelectrodes to the patient.
 16. The method of claim 15, in which thepatient value is a value of an ECG signal or an impedance signal. 17.The method of claim 15, in which the physiological parameter is one ofthe patient's peripheral capillary oxygen saturation, carboxyhemoglobin,methemoglobin, end-tidal carbon dioxide, non-invasive blood pressure,tissue oxygen saturation, temperature, a regional oxygen saturationindex, and an invasive pressure.
 18. The method of claim 15, in whichthe patient value is transmitted automatically responsive to the patientvalue exceeding a threshold.
 19. The method of claim 15, furthercomprising: determining whether the incoming message was received inresponse to the transmitted patient value, and in which if it is not sodetermined, the stored electrical charge is not caused to be so guided.20. The method of claim 19, in which the communication module transmitsan outgoing message to the other device, the patient value is encoded inthe outgoing message, the outgoing message includes a send key code, theincoming message includes a return key code, and the determination isperformed by comparing the return key code to the send key code.
 21. Themethod of claim 20, in which the send key code is generated as a hash ofthe patient value.